| NPI | 1821353830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055512) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA002870) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2022-01-21 |